The VA Hospitals: It's Worse Than We Thought

By R. Alan Clanton | published June 10, 2014 |
Thursday Review editor

Internal investigations rarely produce surprises or game-changing leverage. When GM executives met by video conference with thousands of GM employees worldwide, and later that same day with reporters, the automaker acknowledged there had been problems, accepted responsibility, offered up a new organizational chart, and then stuck with their official narrative—that of 13 confirmed deaths due to an ignition switch problem which dated back more than a decade.

GM’s internal investigation was called by some “the best report money could buy.” There were no real surprises, and despite GM CEO Mary Barra’s apparent sincerity and contrition, there was a general belief that the company will still wage a secondary legal campaign to keep the official death total as low as possible to avoid even heavier and costlier litigation.

Thus, internal audits rarely generate headlines, other than those which are followed by the terms “whitewash” or “sham.” Someone gets thrown under the bus, or someone falls on their sword, to mix metaphors.

So when the Department of Veterans Affairs released its own internal report on the scandal which has rocked the agency over the last months—a scandal which grew so large that former VA chief Eric Shinseki was forced to resign late in May—the real surprise was just how badly the agency appears to have been managed in the last several years.

The audit revealed that the numbers bandied about in the media and the press fall short of reality. The VA’s audit shows that as many as 57,400 U.S. military veterans have waited more than three months to see medical personnel, a figure far worse than the initial estimates by Veterans groups and some in the investigative press. But it gets worse. Among those who signed up for VA medical services within the last ten years, another 64,000 may have never seen a doctor or received any confirmation of an appointment. Most of those 64,000 are still waiting to get appointments.

The VA’s internal audit also confirmed what was already widely suspected: managers and administrators at the VA were routinely awarded bonuses for demonstrating that their facilities were meeting specific benchmarks for scheduling patients for doctor visits and treatment. Many of those administrators, under extreme pressure, had resorted to gaming the system—essentially manipulating the computer data to create false numbers. Phony lists were created showing that patient wait times were falling within a 14-day window, when in fact many veterans were waiting for months even to get an appointment.

Senator John McCain (R. Arizona) has called for the Justice Department to launch an investigation to determine if criminal prosecution is warranted. Early in June several members of Congress said that they would ask the VA to require that those bonuses be paid back in full if it is proven that bonuses were awarded based on falsified medical records. Just before his resignation as VA Secretary, General Shinseki fired several Phoenix VA hospital administrators. Shinseki also put the brakes, at least temporarily, on the performance bonus program.

The VA’s internal audit also revealed another widely suspected facet of the expanding scandal: the manipulation of the records and the creation of fake wait-time lists were widespread and not limited to facilities in Arizona. The problem has been nationwide, and phony wait-lists have been shown to have been routine in hospitals and care centers in Colorado, Illinois, Wyoming, Texas, Florida and Georgia. According to those interviewed for the review, at least ten percent of VA employees say they were given supervisory or peer instruction on how to falsify scheduling times and waiting lists. The report said that two-thirds of all VA facilities had engaged in some form of manipulation when it came to scheduling patient appointments.

Whistleblowers have come forward from scores of VA locations to reveal that supervisors and managers expected employees to participate in gaming the system, and the number of facilities involved could run into the hundreds. For its internal investigation, the VA looked at more than 700 facilities and interviewed approximately 4000 Veterans Administration employees.

Though the issue has political consequences across-the-board, the potential for damage to Democrats is more profound as November looms closer and Republicans hope to gain seats nationally in the off-year elections. Many in the GOP have pointed the finger at President Obama, suggesting that he has not lived up to his 2008 campaign pledge to support veterans and to improve conditions for those who have returned home from the battlefield.

Democrats have said the issue is bipartisan, and not the result of any one party or one person’s action. Both parties are promising to take a more proactive role in an overhaul of the VA, including the possibility of legislation to expand health care to veterans.

“American veterans are depending on us,” said Senate Majority Leader Harry Reid (D. Nevada), “completing legislation, ensuring that our veterans are getting the care and resources they are promised by a grateful nation.”

Richard Griffin, acting inspector general for the VA, said in May that he is engaged in a deeper review of 42 facilities to see if managers and supervisors should be fired, or to determine if criminal prosecution should be considered. But the current report was worse than what was shown to Congress during meetings in May.

Griffin also said he agrees with the Government Accounting Office, and some in Congress, who feel that an independent, outside investigation is now warranted.


Related Thursday Review articles:

The VA's Growing Scandals; Earl Perkins; Thursday Review; May 12, 2014